A nurse-coached exercise intervention to increase muscle strength, improve quality of life, and increase self-efficacy in people with tetraplegic spinal cord injuries

Abstract

Ten people with tetraplegic spinal cord injuries participated in a nurse-coached exercise intervention/single subject design study over a period of six months. Four pieces of exercise equipment were used: the RT300S Functional Electrical Stimulation Bike, the VIta Glide, the NuStep TRS 4000, and the Easy Stand Evolv Glider. Measurement of variables of the Manual Muscle Test (MMT), Catz-Itzkovich Spinal Cord Independence Measures (CI-SCIM), and Moorong Self-Efficacy Scale (MSES) were collected at baseline, at three months into the exercise intervention, and at six months (at the conclusion of the intervention). Results were determined by visual analysis of graphs, in keeping with single subject design methods, and statistical analysis of combined data. Of those muscles that demonstrated some strength at baseline, 75% experienced increased strength at three and/or six months into the intervention. Of those muscles that demonstrated no strength at baseline and that were adjacent to muscles that demonstrated some strength at baseline, 66% were found to have increased strength at three and/or six months. Nine of ten participants experienced upward trends in CI-SCIM scores overall (p<.0001). The results of the subscales of Self-Care (p<.0001) and Mobility (p<.0001) indicated statistically significant changes over time. The subscale Respiratory and Sphincter Management was not statistically significant (p>.05). Visual analysis of graphs demonstrated that each of ten participants experienced strong improvements in self-efficacy scores from baseline to three months and from three months to six months into the intervention. R-ANOVA (p<.0001) confirmed statistical significance across ten participants. The Sheehy Spinal Cord Injury Functional Improvement Via Exercise (SCI-FIVE) Model was constructed prior to the study and validated throughout the course of the study. The results of the study validated all components of the Model and demonstrated increased muscle strength, increased self-efficacy, and improved quality of life for the ten study participants who participated in a nurse-coached exercise intervention for people with tetraplegic spinal cord injuries.